Modimolle Local Municipality

Private Bag X1008, Modimolle, 0510

Tel: 014-718-2000

Fax: 014-717-4077

Application for employment
A. THE ADVERTISED POST
Position for which you are applying?
(as advertised) / Department where the position is advertised?
Reference number ?
(as stated in the advertisement) / If you are offered the position, when can you start OR how much notice must you serve with your current employer?
B. PERSONAL INFORMATION (Please ignore if you have attached a CV with ALL the following information)
Surname
First names
Date of birth
Identity number
Race / African / White / Coloured / Indian
Gender / Female / Male
Do you have a disability? / Yes / No
If yes, state briefly the state of disability
(This information is required to assist the Municipality to comply with the Employment Equity Act of 1998)
Are you a South African citizen / Yes / No
If "No", what is your nationality?
Have you been convicted of a criminal offence or been dismissed from employment? / Yes / No
If your profession or occupation requires State of Official Registration, provide date and particulars of registration.
Are you in possession of a valid drivers licence?
If "Yes" - what code?
Are any of your relatives or acquaintances employed by the municipality? If yes, state name, department and relationship.
C. HOW DO WE CONTACT YOU?
Preferred language for correspondence?
Telephone number during office hours?
Preferred method for correspondence / Post / E-mail / Fax
Postal Address:
Residential Address:

CONFIDENTIAL WHEN COMPLETE

D. LANGUAGE PROFICIENCY? (State "good", "fair" or "poor")
Language
Speak
Read
Write
E. QUALIFICATIONS (Please ignore E, F & G if you have attached a CV with these details)
SECONDARY EDUCATION:
Name of School/Technical College? / Highest qualification obtained? / Year obtained?
TERTIARY EDUCATION (Complete for each qualification you obtained)
Name of institution? / Name of qualification? / Year obtained?
F. WORK EXPERIENCE
Employer (including current employer) / Post held / From / To / Reason for leaving
MM / YY / MM / YY
If you were previously employed by the Local Authority, indicate whether any condition exists that prevent your re-appointment. / Yes / No
If yes, provide the name of the previous employing department.
G. REFERENCES
Name / Relationship to you / Tel. No (Office hours)
H. DECLARATION
I declare that all the information provided (including attachments) is complete and correct to the best of my knowledge. I understand that any false information supplied could lead to my application being disqualified or my discharge if I am appointed.
SIGNATURE: / DATE:

NOTE: Please do not attach original certificates, only certified copies.

Application Form for Employment